Thoracentesis is needle aspiration of fluid from a pleural effusion. Thoracentesis may be done for diagnosis and/or therapy. Related procedures, including needle, catheter, and tube thoracostomy, are done for therapeutic purposes, such as treating pneumothorax or draining certain pleural fluids.
Indications for Thoracentesis
Diagnostic thoracentesis:
Diagnosis of a pleural effusion (in almost all patients) that is new or of uncertain etiology and is ≥ 10 mm in thickness on computed tomography (CT) scan, ultrasonography, or lateral decubitus x-ray (see figure Diagnosis of Pleural Effusion)
Diagnostic thoracentesis is usually not needed when the etiology of the pleural fluid is apparent (eg, viral pleuritis, typical heart failure).
Therapeutic thoracentesis:
Relief of symptoms in patients with dyspnea caused by a large pleural effusion
Contraindications to Thoracentesis
There are no absolute contraindications to thoracentesis. Relative contraindications include the following:
Bleeding disorder or anticoagulation that cannot be corrected
Altered chest wall anatomy
Cellulitis or herpes zoster at the site of thoracentesis puncture
Intractable coughing
Inability or unwillingness to cooperate
Pulmonary disease severe enough to make complications life threatening
Procedure for Thoracentesis
Transthoracic needle biopsy is usually done by an interventional radiologist, often with a cytopathologist present. The procedure and complications of thoracentesis are discussed in How To Do Thoracentesis.
